1255573358 NPI number — ROBERT J SEVENICH M.D.,J.D.,P.A.

Table of content: (NPI 1255573358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255573358 NPI number — ROBERT J SEVENICH M.D.,J.D.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT J SEVENICH M.D.,J.D.,P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOUSECALLMN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255573358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
855 VILLAGE CENTER DR STE 181
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH OAKS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55127-3016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-444-8512
Provider Business Mailing Address Fax Number:
651-414-0279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1714 HOWARD ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLEWOOD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55109-4842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-509-5522
Provider Business Practice Location Address Fax Number:
651-414-0279
Provider Enumeration Date:
04/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
POLSKI
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
651-444-8512

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 903318100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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